Stents?....fad medicine?...or the latest life saving advance? Food for thought. (beware, its long) Merely MY opinion, mind you. Each to their own of course. Dr. David Hillis, an interventional cardiologist at the University of Texas Southwestern Medical Center in Dallas, ranked as one of the top 100 cardiologists in the USofA explained: If youre an invasive cardiologist and Joe Smith, the local internist, is sending you patients, and if you tell them they dont need the procedure, pretty soon Joe Smith doesnt send patients anymore. Sometimes you can talk yourself into doing it even though in your heart of hearts you dont think its right. A patient typically goes to a cardiologist with a vague complaint like indigestion or shortness of breath, or because of a failed stress test, or because a scan of the heart indicated calcium deposits—a sign of atherosclerosis, or buildup of plaque. The cardiologist puts the patient in the cardiac catheterization room, examining the arteries with an angiogram. Since most people who are middle-aged and older have atherosclerosis, the angiogram will more often than not show a narrowing. Inevitably, the patient gets a stent. Its this train where you cant get off at any station along the way, Dr. Hillis said. Once you get on the train, youre getting the stents. Once you get into the cath lab, something WILL be done. “One reason for the enthusiastic opening of blocked arteries is that it feels like the right thing to do, Dr. Hillis said. I think it is ingrained in the American psyche that the worth of medical care is directly related to how aggressive it is, He went on to say, Americans want a full-court press. They insist on some type of intervention. Even when research proves it isnt intervention at all. He says he has tried to explain the evidence to patients, to little avail. You end up reaching a level of frustration, he said. I think they have talked to someone along the line who convinced them that this procedure will save their life. They are told if you dont have it done you are, quote, a walking time bomb. Which in the majority of cases is nonsense. A money making scheme? Stents cost on average thrice what plain old angioplasty cost. But hey, insurance pays, so why not? Note: Angioplasty is the technique of mechanically widening narrowed or obstructed arteries, the latter typically being a result of atherosclerosis. An empty and collapsed balloon on a guide wire, known as a balloon catheter, is passed into the narrowed locations and then inflated to a fixed size using water pressures some 75 to 500 times normal blood pressure (6 to 20 atmospheres). The balloon forces expansion of the inner white blood cell/clot plaque deposits and the surrounding muscular wall, opening up the blood vessel for improved flow, and the balloon is then deflated and withdrawn. Stents may or may not be utilized during the balloon expansion. Angioplasty alone has an effective ten year success rate. Stents (factoring in complications from stents) have an effective four and one half year success rate. Is money is the driving force? Everybody gets paid to put in stents, the hospital gets paid, the doctor gets paid, the stenting company gets paid. They get paid even more when failures return in four and one half years vs ten years. One other disturbing stat, the volume of stent intervention among Medicare patients has gone up over 150% between 2009 and 2013, disregarding the fact that studies prove angioplasty alone is a longer lasting prevention. Stenting belongs to one of the bleakest chapters in the history of Western medicine, says Nortin Hadler, a professor of medicine at the University of North Carolina at Chapel Hill. Cardiologists he said, continue to conduct these procedures because the interventional cardiology industry has a cash flow comparable to the GDP [gross domestic product] of many countries and doesnt want to lose it. A quick psychological fix to placate nervous patients? IMO, yes. A money making scheme for fat cats? According to EVERY study conducted over the past eleven years, absolutely.
Posted on: Tue, 02 Sep 2014 16:32:31 +0000
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